Different types of PCOS

So, I have touched on the fact that my PCOS is caused by Insulin Resistance but did you know that there are 4 different types of PCOS?

In order to treat PCOS, we need to understand what is causing it. Now, I am going to confuse you a little, but bear with me. Despite the name, PCOS has absolutely nothing to do with cysts on the ovaries. The things on the ovaries that your doctor sees on an ultrasound are not cysts, but rather eggs, which are normal for the ovary. The eggs just got stuck because they didn't get the right signal to get released for ovulation to happen.

Your doctor is the only one who can determine whether you have PCOS by using scans and blood tests. I believe in quantitative values to determine a condition. There's nothing more factual than numbers from a blood test, when tests are done correctly. For years I knew I had insulin resistance but it is only in the past three years while seeing an excellent doctor that I realised the intricacies of my PCOS, and which tests had been left out in the past. Had it not been for him, I would still be lost. Numbers and scans don't lie.

However, I implore you, please do not use my blog to undermine your doctor. If you are not happy with your doctor, take a step back and find someone you are comfortable with. It does not mean you have to see the same doctor I went to. Find someone who makes you feel at ease. You are going to need them for a very long time.

1. Insulin Resistant PCOS

Insulin resistance basically means that you have too much Insulin in the bloodstream. It is also known as Metabolic Syndrome or pre-diabetes.

Now read this carefully, as I made this mistake and I do not want you to do the same . A blood test needs to be done to check for INSULIN, not Glucose. So sometimes you will have a blood glucose monitoring machine at home and keep checking your glucose levels, because your dietician or someone said you have prediabetes. The tests can show up as being within normal range, meanwhile your Insulin levels are really high and causing havoc in the background. (I promise to go in depth with this)

Note: 70% of PCOS diagnoses are insulin-resistant PCOS.

Did your doctor test for the hormone insulin or only glucose? A test for blood glucose or HbA1c is NOT a test for insulin resistance. If that is what happened, insist on getting a test to check for insulin levels in the blood. I had seen a doctor once who told me there is no such thing as insulin resistance. My blood tests for HbA1c and blood glucose were normal at the time so he completely dismissed the idea of Insulin Resistance. I knew my body better so I graciously thanked him for his help and proceeded to find a new doctor.

2. Post Pill PCOS

I don't think that I have mentioned that PCOS is due to a high level of hormones known as Androgens. Androgens are hormones like Testosterone for example. So, it is very common to experience a surge in androgens after coming off a drospirenone or cyproterone pill like Yasmin, Yaz, Diane, or Brenda.

This type of PCOS is temporary and will level off once the body gets used to not having the pill in the system. However, you must rule out other reasons for the rise in androgens first for this to be the cause of your PCOS. For example, did you have issues before you went on the pill? If not, and if you have been diagnosed with not having insulin resistance then it could be PCOS caused by withdrawal from the pill.

3. Inflammatory PCOS.

Chronic inflammation can stimulate the ovaries to make too much testosterone and is a contributing factor for every type of PCOS.

When chronic inflammation is the primary factor or most dominant reason, it’s inflammatory PCOS.

The treatment for inflammatory PCOS is to find out what is causing the inflammation. For example, avoiding dairy or a food intolerance.

Again, you have to rule out other causes of PCOS first for this type to be the main cause of PCOS.

4. Adrenal PCOS

Most women with PCOS have an high levels of all androgens including testosterone and androstenedione from the ovaries and DHEAS from the adrenal glands.

OK, so what does that mean exactly? Androgens are the "male" hormones. Both men and women have them in order to create balance. (Think Yin and Yang). Women normally have low amounts of androgens in the system as compared to men and men have low amounts of estrogen compared to women. Balance.

But what is DHEAS? Basically, DHEAS (Dehydroepiandrosterone sulfate) is the androgen that is released from the adrenal glands that are situated on top of the kidneys. These glands release hormones in response to stress.

So, if you have only elevated DHEAS, but normal levels of the other androgens, then you may have adrenal PCOS, which accounts for about 10% of PCOS.

5. Prolactin PCOS.

From my recent research, as I am always reading up on PCOS, there seems to be a 5th type of PCOS that I was not aware of. High levels of PROLACTIN hormone.

High levels of Prolactin can be caused by:

• Hypothyroidism caused by Hashimoto's thyroiditis.

• Elevated Estrogen levels due to diet and external factors.

• Certain medications and chronic psychological stress.

• Pituitary tumour.

Basically, prolactin is the hormone normally produced after you have a baby so you can produce breast milk. It is also produced in order to prevent ovulation, which is why some women who exclusively breastfeed do not get a period, so it works as a contraceptive method for them. In women who are not breastfeeding or who have not given birth recently, having high levels of prolactin disrupts ovulation and again, the eggs get stuck in the ovaries as ovulation didn't happen, thus leading to PCOS.

With this type of PCOS, numerous tests would need to be run to find the root cause.

I know this is a VERY long post but I really hope this sheds some light on the various types of PCOS and maybe give you some more information on what happens within the VERY complicated bodies we have as women.

Please do not hesitate to comment if there is something I missed out or if I made a mistake somewhere. I would love to hear from you!

The following links may provide some insight: https://www.verywellhealth.com/hypothyroidism-pcos-link-2616554#pcos-and-hashimotos

https://nicolejardim.com/pcos-high-prolactin-levels-premature-ovarian-failure-comm

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